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Feed provided by Rheumatology Research. Click to visit.A therapeutic role for potassium (K) to reduce pain and complications related to the ...http://www.rheumres.org/article_48075_6091.html
Rheumatoid arthritis is a painful inflammatory disorder. Patients seek relief mostly with analgesics and anti-inflammatory drugs which are rife with life-threatening side effects. Alterations in the body&rsquo;s potassium (K) status may be one such factor. K along with sodium is critical to cellular homeostasis and the electrophysiology of nerve impulses. This review is based on the premise that K can be used therapeutically to reduce joint pain and inflammation in RA and co-morbidity. K ion channel inhibition was shown to cause persistent nerve stimulation (a prelude to pain sensation) and altered immunity (T cells) in experimental studies. Diets rich in K (with normal/reduced salt intake) have to reduce hypertension in several large population studies. Premature atherosclerosis-related cardiovascular disorders and osteoporosis are important complications of RA. The third National Health and Nutrition Examination Survey (1994) carried out in the USA also reported hypokalemia in several RA patients. A diet deficient in K in RA patients was recently reported by an Indian study. In a controlled clinical trial (Iran), K supplementation (diet-based) led to a significant reduction in pain and arthritis in women suffering from seropositive RA. Some of the benefits of K in RA were postulated to be due to an improved cortisol status. K is not a known therapeutic agent in the treatment of RA. Vegetables and fruits are rich sources of K and provide a safe option for intervention. The existing data on the potential therapeutic role of K in RA is encouraging and merits further research.&nbsp;Sun, 31 Dec 2017 20:30:00 +0100Association of IL-23R gene rs7517847 T>G SNP and susceptibility to systemic lupus ...http://www.rheumres.org/article_50580_6091.html
Previous articles have evaluated the association between IL-23R gene rs7517847 T&gt;G SNP and systemic lupus erythematosus (SLE). Nevertheless, the results of these studies have been inconclusive. The current study is a meta-analysis that assesses the association between IL-23R gene rs7517847 T&gt;G SNP and SLE susceptibility. Literature searches of Medline, Web of Science, and EMBASE databases were performed to recognize all eligible studies published before August, 2016, and the search was updated in July, 2017. The identified studies were independently reviewed by two authors for eligibility based on inclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were applied to assess the strength of association in the allelic model, dominant model, recessive model, heterozygotes contrast, and homozygotes contrast. Because evidence of heterogeneity was detected across the studies, the data was pooled using a random-effects model. A sum of four case-control studies with 1348 SLE patients and 1754 healthy subjects were considered in this study. In the combined analysis, no significant association between the IL-23R gene rs7517847 T&gt;G SNP and SLE disease risk was found in any of the genetic models (dominant model: OR = 0.95, 95% CI = 0.72-1.18; allelic model: OR = 1.08, 95% CI = 0.95-1.21; recessive model: OR = 1.13, 95% CI = 0.80-1.46; TG vs. TT: OR = 0.86, 95% CI = 0.63-1.08; and GG vs. TT: OR = 1.20, 95% CI = 0.81-1.60). Moreover, no publication bias was observed in any genetic models (p&gt; 0.05). First, this study was based on unadjusted ORs. Second, the number of included case-control articles was small. Third, only published English language studies were imported to this meta-analysis. The current meta-analysis suggests that the IL-23R gene rs7517847 T&gt;G SNP might not be related with risk of SLE. More studies are essential to confirm these results. No association was found between the IL-23R gene rs7517847 T&gt;G SNP and SLE risk.Sun, 31 Dec 2017 20:30:00 +0100Prevalence of Inflammatory Rheumatic Diseases in a Rheumatologic outpatient clinic: analysis of ...http://www.rheumres.org/article_50581_6091.html
Inflammatory rheumatic diseases are a heterogeneous class of often chronic autoimmune disorders. They are among the most common chronic diseases. They cause major health problems in the general population. This study assessed the distribution of inflammatory systemic rheumatic diseases in a rheumatologicoutpatient clinic. The medical records of patients diagnosed with any type of inflammatory rheumatic disease between January 1, 2006 and December 31, 2016 in a non-hospital-based rheumatologic outpatient practice in Mashhad, Iran were retrospectively studied. Diagnoses were made using the agreed-upon classification criteria. Data regarding each patient&rsquo;s diagnosis, age at onset of disease, and gender was extracted from their files. The total number of patients was 12,626. The most common diseases were rheumatoid arthritis (47.30%), spondyloarthropathies (17.23%), systemic lupus erythematosus (8.10%), gout (7.84%), and vasculitis (6.84%). Patients were aged from 1 to 93 years, with a mean age of 41.17&plusmn;39.70 years. Most patients were in the third, fourth, and fifth decade of life. Sixty-four percent of all patients were female. The overall sex ratio (women to men) was 1.8:1. The proportion of women was 95% in Takayasu's arteritis, 92% in systemic lupus erythematosus, 87% in Sj&ouml;gren&rsquo;s syndrome, 78% in rheumatoid arthritis, and 24% in ankylosing spondylitis. The age at onset of inflammatory rheumatic diseases in Mashhad, Iran is lower than that in some other regions. The frequency of Behcet's disease, systemic lupus erythematosus, and systemic sclerosis was greater in this study than in most other studies, but gout, polymyalgia rheumatica, and psoriatic arthritis were less frequent in the current study.Sun, 31 Dec 2017 20:30:00 +0100Investigating the short-term impact of cognitive-behavioral therapy (CBT) on quality of life in ...http://www.rheumres.org/article_47871_6091.html
This study evaluated the effect of cognitive-behavioral therapy (CBT) compared with other treatments on improving the quality of life in rheumatoid arthritis (RA) patients. This study was carried out in a rheumatologic referral clinic at an academic hospital. RA patients were categorized in three subgroups: cognitive behavioral therapy group, educational therapy group, and conventional treatment as the control group. Quality of life was assessed with the Arthritis Impact Measurement Scales (AIMS-2) questionnaire. The CBT subgroup (n=30) received cognitive-behavioral treatment with 7 two-hour sessions twice a week; the educational therapy group (n=30) received education about nutrition and osteoporosis, while controls (n=30) received conventional RA medical treatment. Outcomes were gathered in 14 domains of AIMS-2 including activity, walking, pain, self-care, social activity, depression, and anxiety. The 90 studied patients comprised 72 female patients (80.0%) with a mean age of 41.7 years. The degree of improvement in physical activity (p=0.2), hand/finger function (p=0.18), arm function (p=0.28), social activity (p=0.6), satisfaction (p=0.05), household tasks (p=0.9), health perception (p=0.3), self-care ability (p=0.59) showed no significant difference between the three subgroups. Moreover, CBT was effective in improving mood, ability to walking and bend, working, reducing pain and tension, and these effects were independent of age, gender, or education. Additionally, education about nutrition in RA patients improved their ability to work and their mood, and it effectively reduced tension. Based on the findings, CBT is a recommended modality adjunct to RA medical treatment. CBT is specifically beneficial for patients with depressed mood, problems in walking, bending or working, and in subjects who are suffering psychosocial tension.Sun, 31 Dec 2017 20:30:00 +0100Association study of CCR6 gene single nucleotide polymorphism with susceptibility to rheumatoid ...http://www.rheumres.org/article_49151_6091.html
Several genome-wide association studies (GWASs) have identified numerous susceptibility genes for risk of rheumatoid arthritis (RA). Moreover, a bulk of the individual association studies in various populations has disclosed that genetics are significantly responsible for RA pathogenesis. CCR6 is a chemokine which is involved in the infiltration of inflammatory cells to sites of immune response. In this study, the association of CCR6 gene rs1854853 single nucleotide polymorphism (SNP) with susceptibility to RA was evaluated in an Iranian population. The investigated population comprised 250 RA patients and 500 healthy individuals. Real time TaqMan MGB-based PCR allelic discrimination approach was employed to genotype the samples with regard to the CCR6 gene rs1854853 SNP. Considering the A allele of rs1854853 SNP as reference, the G allele did not demonstrate a different prevalence between RA patients and controls (p= 0.17). Moreover, AG and GG genotypes were almost equally distributed between cases and controls (p= 0.61 and 0.14, respectively). Alternately, the dominant model of AG+GG had no significant difference in frequency between the study groups (p= 0.36). However, genotypes did show a correlation with the clinicopathological specifications of RA patients. Results suggest that the CCR6 gene rs1854853 SNP is not involved in the genetic pathogenesis of RA in the Iranian population.Sun, 31 Dec 2017 20:30:00 +0100Concurrent psoriasis and gouthttp://www.rheumres.org/article_47936_6091.html
Hyperuricemia is reported to have a high prevalence in patients with psoriasis. This metabolic derangement can be associated with the development of gout in such patients. Presented herein is the case of a 53-year-old male who referred to the hospital because of worsening of skin lesions and multiple swollen and painful joints. Physical examination showed symmetric involvement of the patient&rsquo;s knee, first metatarsophalangeal, and subtalar joints. Knee fluid aspiration revealed numerous monosodium urate monohydrate (MSUM) crystals. The patient&rsquo;s serum uric acid level was 10 mg/dL. Kidney function was normal. Although he had experienced a similar episode two years earlier with involvement of the first metatarsophalangeal joint, he did not seek medical attention then and was not receiving prophylaxis for gout. Treatment with prednisone, allopurinol, colchicine, and sulfasalazine resulted in improvement of the symptoms. The patient was followed for six months and no relapse in his skin conditions or gouty attacks were observed. It is prudent to measure uric acid levels in psoriatic patients. Psoriatic patients with hyperuricemia, even without a known cause for hyperuricemia, are at increased risk of developing gouty arthritis. This presentation suggests that psoriasis can be an independent risk factor for gouty attacks, though this requires further larger studies.Sun, 31 Dec 2017 20:30:00 +0100Serum Osteocalcin Levels in Postmenopausal Osteoporotic Women Receiving Alendronatehttp://www.rheumres.org/article_50063_0.html
Aim:Osteoporosis characterized by low bone mass, changes in microscopic structure of bone and increased bone fragility. Monitoring response to treatment is critical for the appropriate management of osteoporosis. Serum osteocalcin has become as a bone formation biomarker for evaluation of treatment response in postmenopausal osteoporosis. In present study, we aimed to assess the effect of alendronate on serum osteocalcin levels in patients with postmenopausal osteoporosis. Method:Thirty-four women with postmenopausal osteoporosis received alendronate 10mg/day for 3 months. Osteoporosis diagnosed by DEXA. Serum osteocalcin, calcium, phosphorus and alkaline phosphatase(ALP) were measured at baseline and after 45 and 90 days. Results:Mean age and duration of menopause were 57.91±7.68 and 9.37±8.43 years, respectively. Mean serum osteocalcin at baseline was 15.27±3.7ng/ml, which decreased significantly after 45 and 90 days treatment with alendronate(P=0.009 and PMon, 11 Sep 2017 19:30:00 +0100CD26 mRNA expression in Systemic Lupus Erythematosushttp://www.rheumres.org/article_50177_0.html
Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease involves several organs. CD26 is a multifunctional molecule that has an extracellular domain with Dipeptidyl Peptidase IV activity, in which digest some crucial inflammatory molecules. On the other hand, CD26 plays quite an important role in T cell activation, and enhances the immune responses. This study, carried out to evaluate the level of CD26 gene expression in SLE patients. Methods: Forty-six SLE patients and 44 healthy controls voluntarily participated in this study. Based on the SLE disease activity index (SLEDAI), patients were divided into two subgroups, including patients with active disease (n = 24), and patients with inactive disease (n = 22). Moreover, according to renal involvement, patients were sub-grouped to patients with lupus nephritis (n = 17) and non-nephrotic patients (n = 29). CD26 mRNA level in peripheral blood cells was analyzed by quantitative RT-PCR.Results: CD26 mRNA expression 3.6 times increased in SLE patients in comparison with controls (P < 0.0001 ). However, no difference was found in the level of CD26 mRNA between SLE patients with active or inactive disease (P > 0.05 ). Even though, CD26 mRNA expression in patients with lupus nephritis was 2.76 times higher than non-nephrotic patients, but there was no statistical difference (P > 0.05 ).Conclusion: CD26 gene expression in peripheral blood cells of SLE patients significantly increased than controls. This increase was not affected by the disease activity, and did not show any significant correlation with complications in organsFri, 15 Sep 2017 19:30:00 +0100The Prevalence and Type of Pulmonary Involvement in Ankylosing Spondylitis in Iranian patientshttp://www.rheumres.org/article_51025_0.html
Background: Ankylosing Spondylitis (AS) is one of the chronic and inflammatory diseases that affecting the spinal column and peripheral joints.Pulmonary manifestations in patients with ankylosing spondylitis are rare and usually asymptomatic, and include: restrictions fibrobollous apical, chest wall disease, spontaneous pneumothorax, and obstructive sleep apnea.Method: This is a cross-sectional study. It was performed on 60 patients with AS. All patients had modified New York Criteria 1984. Bath Anlylosing Spondylitis Disease Activity Index (BASDAI) and Bath Anlylosing spondylitis Functional Index (BASFI) and CRP, ESR were measured for all patients. All patients were visited by rheumatologist and pulmonologist and for all patients the pulmonary function test (PFT) and chest x-ray (CXR) were performed. High-resolution computed tomography (HRCT) was performed only in patients who were abnormal in clinical examination or in PFT results and CXR. Result: 50 patients had normal CXR (83.3%) and 10 patients (16.7%) abnormal CXR included reticulonodular (3.3%) atelectasis (3.3%), lucency (3.3%).Of the 14 cases that were HRCT, only 8(57.1%) had abnormal lung CT scans.Pulmonary Function Test (PFT) was taken from all patients and 15 (25%) patients had abnormal PFT, 11 (18.3%) patients had restrictive pattern and 4(6.7%) patients had obstructive pattern. Conclusion: This study showed that the incidence of lung involvement in our patients with AS is similar to other studies (16%) and in most cases, the involvement of lung is restrictive pattern. Lung involvement in these patients may be asymptomatic.Sun, 15 Oct 2017 20:30:00 +0100Comparing the prevalence of metabolic syndrome in systemic lupus erythematosus, rheumatoid ...http://www.rheumres.org/article_51026_0.html
Objective: Evidence suggest an association between Metabolic syndrome (MetS) and its complications in rheumatologic disorders. It has a proinflammatory role and leads to increased risk of morbidity and mortality too. The aim of the present study was to evaluate and compare the prevalence of MetS in participants with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and psoriatic arthritis (PsA).Methods: Two hundred fifty three patients, including 68 SLE, 140 RA, and 45 PsA were recruited. Demographic, clinical features, and laboratory parameters were compared with age-matched controls (n= 123). MetS was diagnosed according to the 2005 National Cholesterol Education Program (Adult Treatment Panel III) (NCEP/ATP III) and International Diabetes Federation (IDF) definitions. The prevalence of MetS was compared between patients and controls. Statistical analysis was performed in SPSS version 19, and results were considered significant at P< 0.05. Results: The mean age of SLE, RA and PsA patients were 42.14 ± 11.5, 44.00± 9.8, and 44.70±5.0 years, respectively. According to NCEP/ATP III criteria MetS was present in 48.5% in SLE, 55.5% in PsA, 31.4% in RA, and 34.9% in controls (P=0.007).Conclusion: The prevalence of MetS was high in patients with PsA and SLE , while arterial hypertension were more prevalent in PsA and lower levels of blood sugar were seen more in those with RA. The components of MetS should be routinely investigated in these disorders to make early diagnosis and appropriate management.Sun, 15 Oct 2017 20:30:00 +0100Genetic and Epigenetic Etiology of Autoimmune Diseases: Lessons from Twin Studieshttp://www.rheumres.org/article_51219_0.html
Twin studies have been considered as strong approaches in determining the cause of complex diseases with regard to identification of involvement of multigene, single genes, environmental factors, and possible relation between genetics and environment. The concordance observed among monozygotic (MZ) twins suggest involvement of genetic factors. Nonetheless, MZ twins demonstrate a rate of discordance in different characteristics like proneness towards diseases, despite virtually identical genetic background. Discordance has been suggestive of the involvement of environment, alongside with the genetic factors. AS a result, a bulk of studies has supported the hypothesis that environmental factors can impress the epigenetic construction and, therefore, influence on the disease susceptibility. Twin studies yield data about clinical courses and outcomes of diseases, in addition to the knowledge of genetics, epigenetics, environmental factors, and risk of disease development. To date, genome-wide association studies (GWASs) have reported that genomic variants responsible for only a number of autoimmunity twin cases and were unable to explain the disease discordance among MZ twins. With respect to exploration of epigenetic mechanisms in autoimmunity, discordant MZ twins have been attractive models and remarkably contributing tools. It is essential for the future studies to evaluate the genetic variants as well as epigenetic changes in large size of twin populations. This review discusses around the genetic and epigenetic lessons obtained from studies of twin cases.Mon, 23 Oct 2017 20:30:00 +0100Determination of Prolactin and Sex Hormone in Patients with Sclerodermahttp://www.rheumres.org/article_54142_0.html
Background: This study aimed to determine the serum level of prolactin and dehydroepiandrostenrone (DHEA) in systemic sclerosis (SSC) and their correlation with disease duration and clinical manifestations.Methods: A case control study was done on 26 scleroderma patients and 26 control healthy individuals adjusted for age and sex with case group. Serum levels of DHEA using Radioimmunoassay (RIA) and prolactin using Immune Radiometric Assay (IRMA) were measured in both groups. Moreover, clinical manifestation of the disease, disease duration and fertility status at the time of the study were also determined for each scleroderma patient. Results: Our findings on 26 scleroderma patients (20 females and 6 males with mean age of 44 years old and mean disease duration of 5 ± 3 years old) demonstrated that serum levels of DHEA were significantly lower in scleroderma patients based on sex (male P-value 0.02) and fertility (Fertile women P-value 0.01, Menopause women P-value 0.008). However, no significant difference was found in prolactin serum levels between case and control groups. Moreover, only serum PRL levels correlate significantly with disease duration in fertile women. Conclusion: In contrary to previous studies, this study manifested that serum PRL did not differ between scleroderma patients and normal individuals. Yet, serum DHEA was shown to be significantly lower in scleroderma patients. Only PRL levels correlate significantly with disease duration.Sun, 17 Dec 2017 20:30:00 +0100Evaluation of oxidant and anti-oxidant balance in Behcethttp://www.rheumres.org/article_54368_0.html
purpose: Behcet disease (BD) is a multi-system, progressive disease which is usually presentsed with oral aphthous and genital ulcers. It may involve other organs such as eye, joints, nervous and vascular systems. Although the origin of BD is unknown, immunological, viral and toxic factors have been proposed to be responsible. The aim of this study is evaluation the oxidant/anti-oxidant balance (Redox Index) in Behcet disease and it's correlation with disease activity. Methods: Thirty BD patients were enrolled the study regard to International Study Group (ISG 1992) criteria. Age and sex matched control group was selected from health hospital staff. 3, 3, 5, 5 tetramethylbenzene (TMB) was used to determine the oxidant/ anti-oxidant balance. In a first enzymatic reaction, TBM was oxidized to a colorful cation. In the second chemical reaction, the colorful cation was regenerated to colorless substance. So, a redox index was achieved.Results: Redox index in BD group was significantly higher than healthy group (P=0.0140). Redox index mean varied significantly in different level of disease activity and was higher in patients with severe disease in comparison with moderate form (P=0.038). There was a direct correlation between disease activity and redox index (r=0.450, P=0.013). A direct correlation was observed between redox index and WBC count in patients (P=0.033).Conclusion: Findings demonstrated the presence of oxidative stress in BD and the severity of BD has a moderate direct correlation with Redox index.Sun, 24 Dec 2017 20:30:00 +0100Evaluation of heart dysfunction in patients with rheumatoid arthritishttp://www.rheumres.org/article_55237_0.html
Introduction: The present study aimed to estimate the left ventricular diastolic function in the patients with RA using conventional Doppler and tissue Doppler echocardiographic imaging (TDI).Materials and methods: This descriptive, cross-sectional study was conducted on 40 patients with an established diagnosis of RA for over five years (2, 7, 9), who referred to the Rheumatology Department and Clinic of Ghaem Hospital, affiliated to Mashhad University of Medical Sciences. The patients with normal electrocardiography, chest examination, and chest radiography were subjected to M-mode, two-dimensional Doppler echocardiography. Data analysis was performed in the SPSS statistical software package (version 11.5). P-value less than 0.05 was considered statistically significant.Results: According to the results, mitral and tricuspid insufficiencies were the most common valvular diseases (72.5% and 52%, respectively). In 70% of the patients, diastolic function was normal, and there was a significant relationship between systolic function and diastolic abnormality. Pulmonary hypertension was detected in 40% of the patients. Nevertheless, no significant relationship was observed between E and Em or between A and Am (P=0.432, P=0.844, respectively). The Mann-Whitney U test revealed a statistical difference between the two groups in terms of EF (P=0.047). Additionally, cardiac contractility was significantly lower in the diastolic dysfunction group. Conclusion: A wide and frequent variety of cardiac diseases, especially mitral, aortic, and tricuspid regurgitation, may be found in the patients with RA. It can be concluded that the active RA patients have a significantly high incidence of diastolic dysfunction in the absence of clinical evidence of heart disease.Tue, 09 Jan 2018 20:30:00 +0100Hypertrophic Osteoarthropathy: Case report and Literature reviewhttp://www.rheumres.org/article_56027_0.html
Hypertrophic osteoarthropathy is an entity manifested by digital clubbing and subperiosteal new bone formation in tubular bone and diffuse skin hypertrophy. It could be either primary or secondary although the secondary form is more prevalent. Many diseases may cause hypertrophic osteoarthropathy like pulmonary diseases, cyanotic heart disease or inflammatory bowel disease. The primary familial form that is also known as pachydermoperiostosis (PDP) and can be inherited in an autosomal dominant or infrequently as an autosomal recessive. We report a 31-year-old man presented with digital clubbing and diffuse skin thickening which was started from puberty. X-ray showed subperiosteal new bone formation. All of the studies for secondary causes were negative.Mon, 22 Jan 2018 20:30:00 +0100Prevalence of Human Papilloma Virus Infections among Women with Systemic Lupus Erythematosus ...http://www.rheumres.org/article_57632_0.html
Introduction: Systemic lupus erythematosus (SLE) has been considered one of a risk factors for cervical cytological abnormalities and high-risk HPV infection. However, there is a scarcity of data about the prevalence of high risk HPV infection in patients with lupus. In order to define strategies for cancer prevention, we aimed to determine the prevalence of HPV infections in women with SLE compared to the control group.Methods and materials: Fifty patients with SLE from SLE clinic in Hafez hospital, Shiraz University of Medical Sciences, were selected and compared to fifty healthy control women from healthy married candidates. In both groups, routine Pap smears were obtained, and the endocervical side of the spatula was sent for analysis of HPV DNA. Frozen samples processing was done for polymerase chain reaction for HPV.Results: HPV infection was detected in 4% (2/50) of lupus patients, but it was not seen in the control group. Typing of HPV showed type 16 and 18 in these two patients. There was no relationship between HPV infection and immunosuppressive medications in our study. Compared with the control group, there was no statistically significant difference between the patients and control group in HPV prevalence (P=0.495).Conclusion: Results of this study showed that SLE and receiving immunosuppressants in patients with lupus were not a risk for high risk HPV infection or cervical dysplasia in our area compared to normal population, but further studies on more patients receiving immunosuppressants and biologics are recommended.Sun, 11 Feb 2018 20:30:00 +0100